RCPA - Rehabilitation and Community Providers Association


DPW Issues Bulletins of Interest
September 14, 2007

The Department of Public Welfare (DPW) Offices of Mental Health and Substance Abuse Services (OMHSAS) and Medical Assistance Programs (OMAP) have issued several bulletins, some with very short implementation timeframes, that may be of interest to PCPA members.

Clarification of Act 169, also known as the Older Adult Protective Services Act (OAPSA), in regard to hiring practices for inpatient and residential facilities, OMHSAS-07-01, was issued August 2 and was effective immediately. The OMHSAS bulletin clarifies that the OAPSA is applicable to all DPW licensed and operated residential facilities for adults. This includes personal care homes, community residential rehabilitation services, long term structured residences, community homes for individuals with mental retardation, family living homes, intermediate care facilities for the mentally retarded (both private and state), state mental hospitals, and nursing facilities. The OAPSA does not apply to outpatient psychiatric clinics. The bulletin identifies the offenses for which a conviction precludes employment in an applicable residential setting. The bulletin is available at www.dpw.state.pa.us/General/Bulletins/003673169.aspx?BulletinDetailId=4089.

Updated Regarding False Claims Provisions of Deficit Reduction Act of 2005-Employee Education About False Claims Recovery [sic], Medical Assistance (MA) Bulletin 99-07-13, was issued September 7 and effective January 1, 2007. This OMAP bulletin reminds providers of responsibilities for employee education about false claims as required by section 6032 of the Deficit Reduction Act (DRA) of 2005, notifies them that the deadline for submitting attestations of compliance was changed to September 30, and provides a revised attestation form. These provisions of the DRA are applicable to entities that receive or make payment of at least $5 million annually in MA payments. This bulletin references MA Bulletin 99-07-01, False Act Claims Provisions of Deficit Reduction Act of 2005 Employee Education About False Claims Recovery (www.dpw.state.pa.us/General/Bulletins/003673169.aspx?BulletinDetailId=4044) that provided guidance for providers on compliance with section 6032 of the DRA.

The updated bulletin stresses that patient pay amounts and payment from MA managed care organizations do not count toward the $5 million threshold. Covered entities must distribute their written policies and procedures to contractors or agents that perform billing or coding functions for the entity, furnish or authorize the furnishing of MA health care items or services on behalf of the entity, or are involved in monitoring of health care provided by the entity. The Centers for Medicare and Medicaid Services (CMS) required OMAP to change the original deadline for submission of attestations of compliance with the DRA from December 1 to September 30. The earlier attestation statement was changed to incorporate CMS guidance. Subsequent annual submission of attestations is required by December 31 of each year for covered entities. Entities that have already submitted the initial attestation need not submit the revised form, although they may do so if they choose. MA Bulletin 99-07-13 is available at www.dpw.state.pa.us/General/Bulletins/003673169.aspx?BulletinDetailId=4091.

Peer Review Committee, MA Bulletin 99-07-14, was issued September 14 and effective September 1. The bulletin is applicable to various provider types, including certified registered nurse practitioners and physicians. The MA Peer Review Committee will perform medical peer review to encourage provision of quality service. The Peer Review Committee advises the Bureau of Fee-For-Service Programs to ensure that applicable providers wishing to enroll in MA have the appropriate credentials and are qualified to provide services and to evaluate the quality of services provided to MA recipients based upon generally accepted community standards of care. The permanent members of the committee will consist of representatives of family medicine, internal medicine, pediatrics, obstetrics/gynecology, psychiatry/neurology, cardiology, and the OMAP Chief Medical Officer. The committee will review enrollment applications and related information and in the future may review credentials of providers already enrolled in MA. The committee will also review the quality of care provided by or concerns raised about the services provided as a result of complaints by MA recipients, Bureau of Program Integrity review, quality improvement activities, or quality of care concerns raised by OMAP staff. The complete bulletin is available at www.dpw.state.pa.us/General/Bulletins/003673169.aspx?BulletinDetailId=4093.

Please contact Betty Simmonds with questions regarding the bulletins.

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